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Original Paper

Free Access

Off-Hour Admission and Outcomes in Patients with Acute Intracerebral Hemorrhage in the INTERACT2 Trial

Sato S.a · Arima H.a · Heeley E.a · Hirakawa Y.a · Delcourt C.a · Lindley R.I.a · Robinson T.b · Huang Y.c · Morgenstern L.d · Stapf C.e · Wang J.f · Chalmers J.a · Anderson C.S.a · for the INTERACT2 Investigators

Author affiliations

aThe George Institute for Global Health, University of Sydney and Royal Prince Alfred Hospital, Sydney, Australia; bDepartment of Cardiovascular Sciences, NIHR Biomedical Research Unit for Cardiovascular Diseases, University of Leicester, Leicester, UK; cDepartment of Neurology, Peking University First Hospital, Beijing, China; dStroke Program and Department of Epidemiology, University of Michigan Medical School and School of Public Health, Ann Arbor, Mich., USA; eUniversité Paris Diderot - Sorbonne Paris, AP-HP Hôpital Lariboisière, Paris, France; fDepartment of Neurology, Yutian County Hospital, Tangshan, Hebei Province, China

Corresponding Author

Professor Craig S. Anderson

The George Institute for Global Health

PO Box M201, Missenden Road

Sydney, NSW 2050 (Australia)

E-Mail canderson@georgeinstitute.org.au

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Cerebrovasc Dis 2015;40:114-120

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Background: Conflicting data exist of an association between off-hour (weekend, holiday, or night-time) hospital admission and adverse outcome in intracerebral hemorrhage (ICH). We determined the association between off-hour admissions and poor clinical outcome, and of any differential effect of early intensive blood pressure (BP) lowering treatment between off- and on-hour admissions, among participants of the Intensive BP Reduction in Acute Cerebral Hemorrhage Trial (INTERACT2). Methods: Subsidiary analysis of INTERACT2, a multinational, multicenter, clinical trial of patients with spontaneous ICH with elevated systolic BP, randomly assigned to intensive (target systolic BP <140 mm Hg) or guideline-based (<180 mm Hg) BP management. Primary outcome was death or major disability (modified Rankin scale of 3-6) at 90 days. Off-hour admission was defined as night-time (4:30 p.m. to 8:30 a.m.) on weekdays, weekends (Saturday and Sunday), and public holidays in each participating country. Results: Of 2,794 patients with information on the primary outcome, 1,770 (63%) were admitted to study centers during off-hours. Off-hour admission was not associated with risk of poor outcome at 90 days (53% off-hour vs. 55% on-hour; p = 0.49), even after adjustment for comorbid risk factors (odds ratio 0.92; 95% CI 0.76-1.12). Consistency exists in the effects of intensive BP lowering between off- and on-hour admission (p = 0.85 for homogeneity). Conclusions: Off-hour admission was not associated with increased risks of death or major disability among trial protocol participants with acute ICH. Intensive BP lowering can provide similar treatment effect irrespective of admission hours.

© 2015 S. Karger AG, Basel


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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: March 25, 2015
Accepted: May 29, 2015
Published online: July 18, 2015
Issue release date: September 2015

Number of Print Pages: 7
Number of Figures: 1
Number of Tables: 3

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

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